| NPI | 1679233944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 1057768) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1057768) |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2021-12-28 |